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, 5 <br /> STATE OF CALIFORNIA Y- .Do Not Pill In <br /> THE RESOURCES AGENCY ATG <br /> O O 0,� <br /> �UPLICA SPY DEPARTMENT OF WATER RESOURCES 1� � --7 1— <br /> � <br /> eftla this <br /> WATER WELL DRILLERS REPORT State Well No. r <br /> Other Well No. <br /> (1) OWNER: (11) WELL LOG: <br /> Name Rvbart mathem Total depth 'fr. Depth of completed well ft. <br /> Address90 <br /> _101 Pa-pleir Ave- Formation:Deirribe by color,character,size of t6dteridl,and structure <br /> Manteea. (101 j f- it.to ft. <br /> (2) LOCATION OF WELL: Log ' <br /> county San Joaquin Owner's number,if any Rand <br /> Township,Range,and Section <br /> Distance from cities,roads,railroads,etc. <br /> A. <br /> (3) TYPE OF WORK (check): , <br /> New Well Z Deepening El Reconditioning E] Destroying E] <br /> If destruction,describe material and procedure in Item 11. <br /> an- <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: '13 sly <br /> Domestic ® Industrial ❑ Municipal ❑ Rotary <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable 00 <br /> Other ❑ I <br /> 1A anti <br /> (6) CASING INSTALLED: Clay <br /> STEEL:X OTHER: If gravel packed <br /> SINGLEX' DOUBLE ❑ - ' <br /> Gage Diameter <br /> From Co or of From To <br /> ft. ft. Diam. Wail Bore ft. ft. <br /> 901 <br /> 11 <br /> Size of shoe nr well ring: Siae of gravel: <br /> pea <br /> 6estribe joint <br /> (7) PERFORATIONS OR SCREEN: <br /> fype of perforation or name of screen <br /> Perf, Rows <br /> From To per per Size <br /> ft, ft. row ft. in.x in. <br /> (s) CONSTRUCTION: <br /> Was a surface sanitary seal provided? Yes No ❑ TD what depth ft. <br /> Wer any strata sealed against pollution? Yes E] No[] If yes,note depth of strata <br /> W.- I <br /> From fr.to it. <br /> From ft.to ft. Work started8—:Ll1 Completed 19 <br /> 72 <br /> Method of seatingto WELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS: This well was drilled under my jurisdiction and this report is true to the best <br /> of?ny knowledge and heliel. <br /> Depth at'which water was first found, if known ft. <br /> Standing level before perforating, if known ft. NAMEHAnning <br /> g Co - C. <br /> (person,firm,or torporauanJ ( y e or ern r <br /> Standing 1-0 afrer perforating and developing ft. <br /> (10) WELL TESTS: Address <br /> Was pump test made? Yes ❑ N If yes,by whom? <br /> Yield: gal./min.with ft.drawdown after hrs [SIGNED] <br /> Temperature of water <br /> Wac a chemical anal ysSs made? Yes [] No (V el er <br /> Was electric log made of well? Yes ❑ No If yes,attach copy License NO. 116322 Dated , 19 72—Y <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 186 (REV. 9.681 .\ 25179-9809-685DM TR IP LD OSP <br />